Effects of open vs. closed system endotracheal suctioning on cerebral blood flow velocities in mechanically ventilated extremely low birth weight infants

Abstract

The mode of suctioning or ventilation does not influence CBFVs in ELBW infants.

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

“…1,5,14,16 Furthermore, all but 7% of VLBW infants had increases in mean CBFv following suctioning (without preceding decreases), which is consistent with observations by Perlman et al 1 Others using near infrared spectroscopy also observed brief increases in cerebral blood volume after tracheal suctioning. 4,11 In this study, we observed that mean CBFv peaked at 6 min and remained elevated for approximately 25 min after suctioning.…”

“…While some investigators observed that CBF changes returned to baseline within 1 to 2 min after suctioning, 1,4,9 most did not report the duration of CBF disturbances. 5,10,14,16 Moreover, while the large difference in duration of CBF changes noted by us and others may be due to differences in population characteristics, inclusion of small sample sizes, different suctioning techniques, use of pre-oxygenation or sedation policies, and so on, we believe that the main difference and strength of our study is that we examined infants who clinically required suctioning and used continuous monitoring until disturbed physiological variables returned to baseline.…”

“…34 Despite that a majority of previous studies also observed CBF increases, a few investigators reported decreases, 9,10 or brief decreases followed by increased CBF after suctioning. 15,16 One of the studies reporting CBF decreases had few patients, and the other had a majority of infants with IVH. In contrast, our study was relatively larger and all infants were free of IVH.…”

“…Since CBF disturbances following tracheal suctioning have been reported to be independent of the mode of ventilation 10,16 and because mode of ventilation was not an independent predictor of mean CBFv (see multiple regression section below), we combined the data from suctioning sessions of infants on both conventional and high-frequency ventilation for the analysis.…”

“…13 Very brief increases of CBF measures in premature infants have been reported (using both Doppler ultrasound and near-infrared spectroscopy) during tracheal suctioning; 1,4,5,11,14 two additional studies also observed increases in CBF that were preceded by transient decreases in cerebral blood volume 15 and CBF velocity (CBFv). 16 This is concerning because increases in CBF in premature infants and neonatal animals have been shown to play an important role in the development of IVH. 17,18 Other investigators, however, observed decreased cerebral blood volume following tracheal suctioning.…”